I Thought These Days Were Over!!

For many years, in the individual health insurance industry, there have been companies saying that they would put you in a group for $20 per month or $50 per month or $10 per month, and that group protected you from getting cancelled if you were to get sick.

When the politicians were pushing the Affordable Care Act, we again heard them saying if we pass this law, insurance companies will no longer be able to cancel you just because you get sick.

I must refer everyone to section 2742 of the Health Insurance Portability and Accountability Act. This law by the way went into effect in 1996.

discontinue health insurance coverage of an individual in the individual

market based only on one or more of the following:

“(1) Nonpayment of premiums.–The individual has failed to

pay premiums or contributions in accordance with the terms of

the health insurance coverage or the issuer has not received

timely premium payments.

“(2) Fraud.–The individual has performed an act or

practice that constitutes fraud or made an intentional

misrepresentation of material fact under the terms of the

coverage.

“(3) Termination of plan.–The issuer is ceasing to offer

coverage in the individual market in accordance with subsection

(c) and applicable State law.

“(4) Movement outside service area.–In the case of a

health insurance issuer that offers health insurance coverage in

the market through a network plan, the individual no longer

resides, lives, or works in the service area (or in an area for

which the issuer is authorized to do business) but only if such

coverage is terminated under this paragraph uniformly without

regard to any health status-related factor of covered

individuals.

“(5) Association membership ceases.–In the case of health

insurance coverage that is made available in the individual

market only through one or more bona fide associations, the

membership of the individual in the association (on the basis of

which the coverage is provided) ceases but only if such coverage

is terminated under this paragraph uniformly without regard to

any health status-related factor of covered individuals.

As you see in the document, first it says Guaranteed Renewability of Health insurance. The only thing it states about these so called Association plans is that if you are in one you must maintain the membership in the association. It does not protect you from being cancelled if you get sick, as you also says multiple time “coverage is terminated under this paragraph uniformly without regard to any health status- related factor of covered individuals”

Why am I back on the HIPAA kick again?? I was talking to a prospective client last week, and they decided to go with another broker because he was going to put them in a group so she could not be cancelled.

Cancelling her was illegal under HIPAA in 1996 and is illegal under the PPACA in 2014.

Thanks for reading.

Eric Wilson is President of I Sell Health, Inc., a Chicago area insurance agency. He has been cited nationally on ABC, CBS, NBC, FOX and CNN